To HSG or not to HSG? Please share your experiences with me here

[ArtemisTheHunter]

Hello all. I am hoping the collective experiences of MNers may help me resolve a dilemma over whether or not to have the HSG test. In brief: I am 38, TTC over 2 years, 1 early MC last year but otherwise nothing. Day 3 and 21 bloods all fine, DP's SA fine, ovulating regularly with clomid for the past 3 months but still nothing. Time is running out and after another 3 months of clomid the next and final stop for us is IVF.

I have asked about the HSG and my consultant is willing to offer it but has strongly advised against because I am at low risk of tubal damage (no past surgery or infections, tubes didn't show up on pelvic ultrasound) and the test itself carries a risk of infection. However I have heard that the HSG has therapeutic benefits in some cases and that some PCTs use it as a matter of course. Despite obsessive googling careful research I haven't found any formal studies into its benefits. I guess it is preying on my mind now - maybe this is the one thing that could help me get pg naturally and avoid the stresses of IVF.

I know nobody can make the decision for me but would be grateful to hear of your experiences with this test. Does your PCT use HSG as a routine test? If you have had the test and found nothing wrong, do you think it made a difference to your fertility? If you chose not to have it, do you think that was the right decision? Can anyone point me towards proper medical research into whether it's of use where there is low risk of finding a problem?

Thanks in advance for any help!

Yes I had it after 18 months of TTC (I was 31). It hurt quite a lot, and the prophylactic antibiotics they gave me gave me nasty sunburn.

But I conceived the next month - in fact I got pg 3 times within my next 8 cycles. Consultant said "yes, anecdotally that happens a lot"

But - I'd never been pg, and hadn't had an ultrasound and was significantly younger. Given that you've had a mc it's presumably less likely that you're "blocked up".

Very best of luck

Hi Artemis. It was a standard part of the investigative process for me, along with blood tests and an ultrasound. I had it last September. I'd heard about it boosting fertility for a couple of cycles by giving the pipes a good clear out, but the dye shot straight through mine (so there probably wasn't any debris) and as you will know from another thread, I'm still looking for my BFP.

I had no background of abdo surgery (bar one lap many years ago) or any infections. I wasn't thrilled about having it because I had heard it flipping hurt (although I felt nothing more than you would at a smear) and because the antibiotic they give you as standard is in a group I am allergic in (they ended up giving me an alternative that sounded like napalm to gut bacteria so I decided not to take it as I have LBS and have spent years carefully building them up but had to lie because they won't do the test in my area unless you take it but the neighbouring hospital doesn't use antibiotics for HSG at all!). I'm not really sure if I am glad that I had it or not. It turned out to be pointless for me, but if I hadn't had it, I'd probably be fretting about my tubes!

It's all so hit and miss, isn't it?

IBS not LBS!

I had an HSG when ttc my DD. it's part of the standard investigative work they do at my fertility centre. As my constant said, no point in me taking clomid etc if one or both of my tubes are blocked.

I found the procedure very painful which is not the norm! It made me sick and almost passed out. As a result they did it again under GA. and it is supposed to have a 'pro-fertile' effect by giving the tubes a good clear out. I fell pg but sadly mc. I went on to have ov induction (using same drugs as IVF but in much smaller quantities) and fell pg after the 2nd go

So I would have the HSG if it's on offer. Good luck, hope you fall pg really soon.

ttc 2 years, HSG standard diagnostic procedure here (no anti-biotics). Everything looked fine on the ultrasound but HSG showed my left tube was blocked and I had hydrosalpinx. Had an early m/c in Dec and am pretty sure two chemical pregnancies in the previous year.
I've now had a lap and dye to sort out my blocked tube and am on my first cycle post op so only time will tell if it's worked.

I did a lot of reading about hydro and there is some debate about whether the fluid that builds up is embryo toxic. Most of the studies are based on success rates for IVF once hydro is resolved.
Personally if I thought I might end up having IVF i'd want to know what if this was a possible issue.

I had HSG last month, no anti-biotics, as part of initial fertility investigations, including day 3 bloods, internal scans, swabs and SA for DH. I think this is pretty normal first step in my PCT.

During the actual HSG I felt a sharp pain for a minute (was told to take a couple of pain killers 30mins beforehand) or so as the dye passed down my tubes. It came out very easily of both tubes, so not sure if there was anything blocking them. The woman who did the procedure did say afterwards that often ladies find themselves pregnant following a HSG so to make the most of the next few months.

I didn't have any complications to consider and that is really where your decision lies. HTH.

Similar to queen above, my HSG 5 months a go showed up one swollen tube which is likely a hydrosalpinx. It hurt a lot but that isn't a normal experience. Plus I forgot to take my painkillers just before!

As I have already been pregnant and miscarried, it goes to show that either blocked tubes do not prevent occasional conception or that miscarriages can in themselves can be responsible for some tubal damage.

It is unlikely you will have anything wrong with your tubes and on that level it is a good ruling out exercise. But I think Dr's who say tubal damage is unlikley due to lack of infection / PID and surgery and with previous conception are not entirley correct for this was exactly the catagory I fell in to. Tubal problems were the last thing I suspected.

The other interesting thing which I have learnt from my many many scans (due to current IVF cycle) is that fluid in the tubes fill up on some occasions and not others. On some of scans the tubes weren't visible as there was no fluid in there and other scans showed there was. Including in the left tube on some occasions which was not picked up at my HSG. This also makes me wonder if more people have fluid in their tubes than suspected because it doesn't always make its presence known. It does make you wonder about the 'undiagnosed catagory'.

I also think that even if the Dr's do spot tubal problems via HSG - the most recent research points to having IVF to bypass the problem anyway as opposed to direct surgery as this yield better results (this is certainly how my Dr portrayed things). So I often think that if people aren't having HSG's it might not matter to the course of treatment in the long run anyway for significant tubal damage.

I hadn't heard of the HSG causing risk for infections being a significant risk. I know antibiotics can be prescribed in any case.

I was offered a lap after my HSG to see the extent of the damage and clear up any adhesions / blockages in and around the tubes surgically where possible. However I was warned that the chances of that being succeful for natural conception after were slim and as a result I felt it was better to go straight to IVF. It nearly broke my heart in having to make that decsion but now I'm in it, I'm starting to feel better about things.

Hope that helps, but I fear I may have confused you further.

I had an HSG with a history pretty much like yours although I was 35 at the time.

During - felt strange and uncomfortable, after rather blooming painful still in the evening, cramping. I would advise taking medication an hour beforehand and heavy flow pads. And take someone with you if possible, I felt really wobbly on my feet.

I did get an infection after it which wasn't pleasant.

heard the platitudes of people getting pregnant afterwards, I didn't. I'm guessing you know the reason is because the little hairs inside your tubes that waft the egg down can get gunked up and lie flat, the flushing through can clear any gunk and free them to do their job properly.

I'm surprised that you've not been offered one before, especially if they've said IVF next.

Good luck!

I've had a HSG after a couple of years of secondary infertility. It wasn't offered to me as a routine test, as my DH is the one with the fertility problems (low sperm count and motility). But I asked for one as I've have previous abdominal surgery and was worried about scarring to my tubes.

It hurt a lot and it was unsuccessful after 4 attempts as they couldn't get the tube through my cervix to get the dye into the right place. I ended up having a lap and dye under general anaesthetic which was even more traumatic as it involved surgery and a couple of days off work.

And I didn't get pregnant afterwards (but didn't expect to) but they found my tubes in perfect working order :) Due to DHs ongoing issues we are now having ICSI treatment.

Hi. I had a HSG at 30 as a routine part of our fertility investigations. I think 'smarts' is a good word to describe it. It smarted/stung during, apparently because my cervix was very narrow so he had to push through I had a few problems a while after it, I think I went into spasm or had an infection. That was unpleasant but seems quite rare. I had antibiotics and it settled after a few days. I didn't magically get diffed after it - turns out our fertility issues are male factor - but I'm glad I had it done - despite the after affects! - because it gave us more information about what was going on and it was fascinating to see my insides up on screen! :)

Agree with the other posters. I'm 38 and had it done last year. It was part of our routine investigations. My tubes didn't show on the ultra sound, so it was good too have done. It didn't hurt much - just a bit when the Dr had a poke around in the tubes themselves, but nothing more than period cramp. There were a lot of preventative antibiotics, or seemed a lot to me because I usually avoid them, but took them because I was more afraid of what might happen in the (unlikely) event of an infection. Unfortunately it showed tubal damage, but I'm really glad we did it as we got answers. Good luck.

Hi everyone

Thank you so much for sharing your experiences, it has been really helpful. I am interested that so many PCTs do this as a regular early investigation whereas my consultant has actively advised against. I rant frequently on the 10+ thread about different approaches to investigation and treatment across the NHS so i won't go into one here but I am leaning towards having it done. I am very uncomfortable at being declared infertile on the basis of two blood tests, both of which were normal, and I really don't like the idea of invasive and emotionally draining IVF treatment when they haven't done all the basic tests. The fact that several of you have found unsuspected tubal damage makes me think it's worth checking.

The consultant said the test wouldn't change the treatment outcome (if they find a problem the treatment would be IVF, but we're heading that way anyway), however we are looking at a 10-month waiting list. If the HSG finds a problem we can go on the IVF list a bit quicker and I can ditch the temping, ov sticks and other obsessive behaviour during the wait. If there's no problem we may still end up with IVF but at least I know it's worth us carrying on trying in the meantime - and who knows, having the tubes flushed might make a difference. There seems to be plenty of anecdotal evidence that it can help.

The one thing that is worrying me now is how many of you found it painful/had infections following the test despite that supposedly not being the norm!

Still interested in any further comments, but thanks again to those who have taken the time to reply and I hope you all enjoy a lovely weekend in the sunshine

A HSG is a useful test to have done as deformities INSIDE the tube can only be seen on this type of tubal x-ray. It is also useful as it can give information not easily accessible by other methods. It should not hurt providing the dye is injected both slowly and carefully.

Have had this test done and in my case the fear of it was far worse than the actual reality. Was given a couple of painkillers beforehand. My test was done privately as it was not routinely offered in my PCT. They found nothing wrong with my tubal x-ray so did not in itself improve my fertility (laparoscopic surgery did that however as I was subsequently diagnosed with endometriosis).

However, I feel there are wider issues here apart from whether you have a HSG or otherwise. Do you feel as a couple you have been adequately investigated?. Jumping straight from clomid (this should really only be given if there are ovulatory problems) to IVF is a huge jump. I would actually look into receiving a second opinion now.

What about his tests; semen analysis more often than not has to be repeated. How thorough have his investigative tests been?. Presumably they have mentioned IVF as well due to possible male factor issues. Also you need up to date test results; any test result over 6 months old should be discounted. If you have been ttc for over 2 years without success it is likely that there is a problem with either one or both of you equally.

Further to attila's comments. I had the lap and dye to examine (and treat) the tubal problem they discovered, but when I came round from surgery was told it had taken much longer because they found endo while they were in there. This had never been suggested to me as a problem because I didn't think I had any symptoms, but subsequently have had a period which was very different to the previous few years.
I agree with attila that looking for a second opinion is a must.
I have secondary fertility, and wondered if they were being so thorough with me because I am not eligible for IVF under our PCT rules, but talking to aquaintances in the area under the same Consultant they run the same diagnostic tests on everyone here.

Thanks Atilla and Queenrollo, really helpful comments. TBH Atilla no I don't feel we've been adequately investigated but I have not got very far when trying to get anything more than basic blood tests. I don't know if they would be more thorough if I were younger but my age is mentioned as an issue at every meeting. The cutoff for IVF eligibility is 39 at the time of treatment and I think that plus our narrow PCT policy is dictating the investigation and treatment options as much as, if not more than the clinical assessment. The argument seems to be that, because IVF is the treatment option for so many problems, we might as well go to it straight away but like you I think that is a huge jump and also gives us very poor odds overall on a successful outcome. Endo has not been mentioned though I understand it is often symptomless. I've had problems with very painful heavy periods in the past (though not recently) but I very much doubt they would agree to do a lap if they have been so anti the HSG.

DP has had one SA so far and count, motility and morphology were all within normal range, so on that basis they ruled out male factor as the problem. That was done about 6 months ago so he is doing another one next week which includes a 'swim-up' test. We go back for the results in a fortnight so i will hopefully get another crack at hassling the consultant then.

I don't honestly know where I would go for a second opinion - would need to be private I guess, since it's the same consultant who runs all the NHS clinics round here. That might be why he's so hard to get hold of (I've seen him once, previous meetings were with fertility nurses or the registrar). He also does IVF in private practice and in my more cynical moments I wonder whether that has a bearing on his eagerness to recommend IVF. Our PCT only funds one cycle so he must pick up plenty of private patients wanting further attempts when their first round fails.

Atilla did you approach the private clinic directly or through your GP? I've done a bit of googling but the private clinics I've found tend to focus on treatment rather than investigation.

Haven't posted in a long time but really felt I needed to today.

Had HSG on Wednesday as part of initial investigations. Had a internal scan the week before where they saw the wall of my uterus was quite thick. AF started last Friday... like clockwork. I am very regular.

I found the HSG okay. Slight discomfort during it but nothing afterwards at all. Dye spilled out of one tube very quickly but stopped while going through the other one. The woman said it looked like a blockage but I would have to wait and see what my consultant thought. Not sure when I'll hear from him.

DH tests came back all clear. We've been TTC for just about 2 years now. I'm 31.

Beginning to get a bit worried about all this. Holiday in a few weeks so hopefully that will help relax me.

morayrose i was stunned when I was told i had a blockage, and it really hit me emotionally quite hard but I did come through that and out the other side fighting. As you can see i've had mine resolved, but no guarantees it will lead to me getting pregnant.
Hopefully the holiday will take your mind off things and give you some time to relax.

Hi Artemis, a couple of the ttc 10+ monthers got BFP's soon after having an HSG and they were both after quite a long time trying (21 months and 19 months IIRC)

I had my HSG after about 15 or so months of trying, and got my BFP at 19 months, so I guess it could have made a difference. I think it was probably the sperm in our case though!

Just wanted to say not to worry about the pain, for me it was fine and I'm an absolute wimp. I think the majority of people find it ok.

Like others I had a HSG as part of routine tests after 18mths TTC. It showed one blocked tube and small uterine fibroids, which was all a bit of a shock. I had some signs of fibroids, incl. irregular cycles. The consultant was going to do keyhole surgery to look at everything but I fell pg the cycle after the HSG. I was also temping and it was the 5th mth of temping. I believe the HSG gave the (one) tube a clean, the temping helped pinpoint OV, and we did the rest ;0) The test was uncomfortable but worth it for the information it gave us. Good luck x

Hi!
Just had a HSG Test at UCH in London, I was really nervous before taking the test as I had read lots of horror stories online and I just wanted to write about my experience.
The test was very uncomfortable but bearable, when the canala was inserted it did hurt abit but the pain passed quickly. When the dye filled my uterus it felt like bad period pains but it was more uncomfortable rather than very painful.
The guy who did it was brilliant he made me feel at ease and chatted away. He did say that 30% of women don't turn up for the test and that alot of the time women feel pain because they may not have given birth prior or the radiographer wasnt very gentle. It wasnt a pleasant experience but for the end result which we all want (a baby) its definantly worth having done. My results were thankfully good as both tubes were clear. Not sure if this was helpful to anyone but I do hope so!